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Translating Wound Care Evidence into Practice through Journal Clubs

Barbara Fulmer, MSN, GNP-BC, CWCN-AP

Definition

• A Journal Club is “an educational meeting in which a group of individuals discuss current articles, providing a forum for a collective effort

to keep up with the literature.”(American Journal of Critical Care, 2002)

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Literature Review

History

• Founded by Sir William Osler at McGill University in Montreal in 1875

• Review the latest medical evidence

• Application of new knowledge to relevant patient cases

Purpose

•Create awareness of research

•Promote evidence-based practice

•“An educational tool that bridges research and practice”(Westlake, et al, 2014)

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Awareness of Research

•Stay abreast of clinical research

•Enhance literature appraisal skills

•Engage nurses in research and provides the opportunity to debate findings with peers

Promote Evidence-Based Practice

• Critical review of research is an essential component of evidence

• Integrates evidence and practice at the grassroots level

• Empowers nurses with the rationale to implement new evidence into practice

Benefits

• Improves reading habits of participants

• Promotes a better understanding of research process

• Improves ability to critically appraise research

• Enhances self-directed learning

• Encourages social interaction and dialogue with colleagues

• Improves nursing confidence and satisfaction

• Fosters translation of important research into clinical practice

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Barriers to Success

•Attendance

•Relevance

•Participation / Confidence

•Technology

Overcoming Barriers

• Explore formats, location, times, membership

• Champion

• Marketing strategies

• Relaxed, social environment

• Multidisciplinary teams and consultants

• Article selection by members / Question driven

• Education / mentoring / support

• Continuing Education Units

• Clinical “bottom line”

• Document decisions / needed follow-up

• Evaluation

Steps to Success

1. Identify a Champion / Leader

2. Identify goals

3. Who is the audience?

4. Determine the format / location / time

5. Select and share articles

6. Hold the Journal Club meeting

7. Evaluate the meeting and make adjustments

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EMCSkin and Wound Care Journal Club

Pressure Ulcer Prevention and Wound Care Team

• Formed in 2006

• Team goals:

Pressure Ulcer Prevention

Excellence in Wound Care

• The incidence of pressure ulcers has decreased from 16.8% in 2007 to 2% in 2010 and has been sustained at less than 2%

• Activities included an initial and annual review of the literature for pressure ulcer prevention evidence

Skin and Wound Care Journal Club

•Established in 2012

•Program of the Pressure Ulcer Prevention and Wound Care Team

• Identified nursing need for wound care education

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The John Hopkins Nursing Evidence-Based Practice Model

Poe and White (2010)

The John Hopkins Evidence-Based Practice Process

The Johns Hopkins Evidence-Based Practice Process

PET (Practice Question-Evidence-Translation)

Poe and White (2010)

PRACTICE QUESTION EVIDENCE TRANSLATION

Champions

• Wound, Ostomy and Continence nursing team

- APN

- WOCN

- WCC

• Pressure Ulcer Prevention and Wound Care Team

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Journal Club Goals

• Promote nursing professional development in skin and wound care

• Increase knowledge of research methods

• Strengthen literature search and article critique skills

• Translate evidence into practice

• Promote excellent daily nursing care of patients and families through evidence-based practice

Audience and Design

• Meetings are open to all nurses - ancillary staff are welcome – social environment

• Time and location

• Articles are selected and distributed prior

• Journal Club meeting held

• Each article is critiqued and summarized

• Members discuss the evidence and implications for practice

• Consensus is developed

• Evaluate and plan the next meeting

Articles

• Members choose topic/practice question

• Peer-reviewed journals

• Literature search

• Two articles selected

• Shared prior to the meeting

• Posted on TuRNing Point

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Appraisal Process

• American Nurses Association (ANA) “Framework for How to Read and Critique a Research Study”

• John Hopkins Nursing Evidence-Based Practice appraisal tools

• Critical appraisal of evidence for strength and quality

• Summarize individual evidence and overall findings

• Organization Support and Consultants

Translating Evidence into Practice

Increase Clinical Knowledge and Skills

• Desire to improve clinical skills in skin and wound care

• Study and discuss related evidenced-based practice with other interested nurses

• Exemplary daily nursing care of patients and families

• Resource Nurse

• Examples of selected areas of study: pressure ulcers, lower extremity ulcers, nutrition and wound care, incontinent dermatitis, necrotizing fasciitis, lymphedema, topical wound care, hyperbaric oxygen therapy….

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Example

• Practice Question

In hospitalized patients with edema, how is lymphedema differentiated and how can I improve my nursing assessment and intervention skills in caring for patients with lymphedema?

• Journal Club meeting

Multi-disciplinary, including wound care nurses, outpatient and inpatient nurses, Occupational Therapist from the Lymphedema Clinic

• Results

Improved understanding of lymphedema and goals for lymphedema care

Established a new relationship with the OT in the Lymphedema Clinic.

Empowered to discuss appropriate referrals to the Lymphedema Clinic.

Pressure Ulcer Prevention andWound Care Team Development

• Question

In the hospital setting, what are effective measures to sustain a low incidence of hospital –acquired pressure ulcers?

• Journal Club meeting

- Discussion of Evidence-Based Practice findings

- Review the role of teams to eliminate Hospital-Acquired Pressure Ulcers

• Results

- Adopted educational guidelines for Pressure Ulcer Prevention and Wound Care Team members – Online wound care education

- Renewed inspiration and ideas to strengthen the role of team members, including unit audits, education programs and monthly Dash Board reports of unit-acquired pressure ulcers.

Review of Policies and Procedures

• Evidence for skin and wound care policies and procedures reviewed and summarized at regular intervals

• Updates to established policies and procedures recommended

• Approval through Nursing Shared Governance Council

• Examples - Policies and Procedures for assessment and management of wounds, pressure ulcers, skin tears and moisture associated skin damage

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Staff Professional Development in Skin and Wound Care• Evaluation of knowledge gaps and staff

education needs

• Search for the evidence

• Dissemination of evidence

• Examples – Posters, CBL’s, Fliers, Wound Care Unit Rounds

Examples

• Identified need for improved prevention of heel pressure ulcers

Literature review and Wound Care “Snippet” Rounds to disseminate EBP measures

• Identified knowledge deficit of the Braden Scale

Literature review, collaboration with nursing informatics and education class

Nursing Research

Journal Club members contribute to Nursing Research

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Outcomes

Journal Club Evaluations• Objectives Foster awareness of the importance of research to clinical Practice

Develop skills to read and critically evaluate current research

Evaluate the research merit and its applicability to the patient care setting

Generate new knowledge among the participants to improve nursing care and clinical outcomes

Excellent Good Fair Poor

The stated objectives were met 80.5% 19.5%

The article was clear and easy to understand

78% 19% 3%

The content was current and relevant 84% 16%

This was an effective method to learn this content

80% 19% 1%

I can apply the content to my nursing practice

83% 17%

Journal Club Member Comments

Nurses who attend the Journal Club meetings have expressed greater comfort levels with reading and critiquing journal articles. They relate an improved knowledge of the topics studied and greater confidence in their skin and wound care skills. They are active participants in their education through selection of future topics and questions for Journal Club meetings.

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Incidence of Hospital-Acquired Pressure Ulcers

“For nurses who may ask why journal

club participation is important, as Luby

et al (2006) stated, “studying research

reminds us that we are not just nurses

doing tasks, we are scientists practicing

the science of nursing.” ( Lachance, 2014)

References

• American Journal of Critical Care. (2002) What is a Journal Club? American Journal of Critical Care, Sept., 2002.

• American Nurses Association Framework for How to Read and Critique a Research Study. ANA Research Toolkit. www.nursingworld.org/Research-Toolkit/FrameWorkforHowtoReadandCritiqueaResearchStudy

• Dearholt, S.L., Dang, D., eds. (2015). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines (2nd Ed.). Indianapolis, IN: Sigma Theta Tau International.

• Lachance, C. (2014) Nursing Journal Clubs: A Literature Review on the Effective Teaching Strategy for Continuing Education and Evidence-Based Practice. The Journal of Continuing Education in Nursing, 45(12), 559-565.

• Luby, M., Riley, J., Towne, G. (2006). Nursing Research Journal Clubs: Bridging the Gap Between Practice and Research. Medsurg Nursing, 15, 100-102.

• Nesbitt, J, Barton, G. (2014). Nursing Journal Clubs: A Strategy for Improving Knowledge Translation and Evidence-informed Clinical Practice. Journal of Radiology Nursing, 33(1), 3-8.

• Patel, C., DeNigris, J., Chabot, J., Panzera, A., Dunn, R., Conners, S. (2011). Evidence-Based Practice and a Nursing Journal Club. Journal for Nurses in Staff Development, 27(5),227-230

• Poe, S.S., White, K.M., eds. (2010). Johns Hopkins Nursing Evidence-Based Practice: Implementation and Translation. Indianapolis, IN: Sigma Theta Tau International.

• Westlake, C., Albert, N, Rice, K., Bautista, C., Close, J., Timmerman, G. (2014). Nursing Journal Clubs and the Clinical Nurse Specialist. Clinical Nurse Specialist, Jan/Feb, 2015.

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Thank you

ContactBarbara Fulmer

bfulmer@emc.org